Physiotherapy is very effective for the treatment of frozen shoulder, a condition characterised by the shoulder becoming very stiff and very painful to move.
The definative cause of frozen shoulder remains a mystery. In some cases there is known to be a build up of adhesions inside the joint, in other cases the capsule (membrane around all joints) shrinks and there is evidence to suggest capsule in-growth of nerves and blood vessels making the joint sensitive to movement. There are lots of possible contributing factors but 'true' frozen shoulder is insidious (no known cause). If there is trauma to the shoulder then the joint reacts, becomes tighter and a capsular restriction will develop. Another name is 'adhesive capsulitis'. Where we are unsure of a cause we will term this 'idiopathic adhesive capsulitis'.
- Loss of movement – severe
- Pain - Severe
- Pain in shoulder joint, upper arm, neck (may refer down or into the neck because of muscle spasm).
- Pain may descend into elbow and forearm (common referral pattern)
- Pins and needles in the hand and forearm (nerves may get strained due to build up tension in muscles around the neck).
Frozen shoulder has 4 stages: Stage 1 - is very, very sore and painful and is known as the Reactive stage where the capsule is sensitive. The reactive stage lasts for a few weeks to a few months and can persist into the 'freezing stage'. Stage 2 - the arm becomes stiffer to move with persisting pain. We call this the Freezing stage. Stage 3 - this is the frozen stage where the arm is 1/2 to 1/4 limited in all directions. Most painful behind the back. Stage 4: After many months (sometimes years) there is a gradual return to normal movement, we call this the 'Thawing phase'.
Pain in upper arm
Sleep is often disturbed
pain may extend into the wrist and forearm.
Pins and needles may present because muscular restriction causes limitation and compression of nerve tissue.
Gentle sequencing of movement that promotes pain free mobility can help reduce spasm. Joint manipulation of the spine may help restore scapula mobility together with gentle soft tissue mobilisation. Stretching can be painful and achieves little in the initial phases but is useful if tolerated well. At Core Body clinic we also use a specific and non-painful tissue release technique which we call the 'core shoulder approach'. It involves applying pressure to specific points around the shoulder and scapula. This slowly releases the tissue, reduces pain sensitivity in the brain and helps re-educate normal movement. As the arm begins to release, muscle re-education and conditioning are necessary to restore appropriate function.
Other treatments include:
Acupuncture / Dry needling technique is highly effective in pain reduction and tissue release and can be used to access stretching with less pain.
Massage / sports Massage
Trigger point release
REMEBER: Frozen shoudler has a natural history and will get better on its own, although it could take years. Physiotherapy can help speed recovery.
Injection and Surgery
Injecting the arm can help with pain and on occasions surgery can be of benefit. However, even with all the marvels of modern medicine – we do not as yet have a silver bullet solution for the condition. That said, the Core Body Clinic approach is to reduce pain and through this create greater tolerance to pain during movement. In doing so, we often see a gradual but linear return to function.